Median Charlson Comorbidity Index Score Research Articles

Risk-Specific Training Cohorts to Address Class Imbalance in Surgical Risk Prediction.

Machine learning tools are increasingly deployed for risk prediction and clinical decision support in surgery. Class imbalance adversely impacts predictive performance, especially for low-incidence complications. To evaluate risk-prediction model performance when trained on risk-specific cohorts. This cross-sectional study performed from February 2024 to July 2024 deployed a deep learning model, which generated risk scores for common postoperative complications. A total of 109 445 inpatient operations performed at 2 University of Florida Health hospitals from June 1, 2014, to May 5, 2021 were examined. The model was trained de novo on separate cohorts for high-risk, medium-risk, and low-risk Common Procedure Terminology codes defined empirically by incidence of 5 postoperative complications: (1) in-hospital mortality; (2) prolonged intensive care unit (ICU) stay (≥48 hours); (3) prolonged mechanical ventilation (≥48 hours); (4) sepsis; and (5) acute kidney injury (AKI). Low-risk and high-risk cutoffs for complications were defined by the lower-third and upper-third prevalence in the dataset, except for mortality, cutoffs for which were set at 1% or less and greater than 3%, respectively. Model performance metrics were assessed for each risk-specific cohort alongside the baseline model. Metrics included area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), F1 scores, and accuracy for each model. A total of 109 445 inpatient operations were examined among patients treated at 2 University of Florida Health hospitals in Gainesville (77 921 procedures [71.2%]) and Jacksonville (31 524 procedures [28.8%]). Median (IQR) patient age was 58 (43-68) years, and median (IQR) Charlson Comorbidity Index score was 2 (0-4). Among 109 445 operations, 55 646 patients were male (50.8%), and 66 495 patients (60.8%) underwent a nonemergent, inpatient operation. Training on the high-risk cohort had variable impact on AUROC, but significantly improved AUPRC (as assessed by nonoverlapping 95% confidence intervals) for predicting mortality (0.53; 95% CI, 0.43-0.64), AKI (0.61; 95% CI, 0.58-0.65), and prolonged ICU stay (0.91; 95% CI, 0.89-0.92). It also significantly improved F1 score for mortality (0.42; 95% CI, 0.36-0.49), prolonged mechanical ventilation (0.55; 95% CI, 0.52-0.58), sepsis (0.46; 95% CI, 0.43-0.49), and AKI (0.57; 95% CI, 0.54-0.59). After controlling for baseline model performance on high-risk cohorts, AUPRC increased significantly for in-hospital mortality only (0.53; 95% CI, 0.42-0.65 vs 0.29; 95% CI, 0.21-0.40). In this cross-sectional study, by training separate models using a priori knowledge for procedure-specific risk classes, improved performance in standard evaluation metrics was observed, especially for low-prevalence complications like in-hospital mortality. Used cautiously, this approach may represent an optimal training strategy for surgical risk-prediction models.

Central Skull Base Osteomyelitis in Queensland, Australia, 2010–2020

Abstract Background Central skull base osteomyelitis (CSBO) is an incompletely defined, life-threatening infection of the bones of the cranial vault. We describe the clinical features and outcomes of CSBO in Queensland, Australia, over an 11-year period. Methods Medical record coding enquiries identified cases of CSBO across 6 tertiary hospitals in Queensland, Australia, from January 2010 to December 2020. Epidemiological, demographic, diagnostic, management, and outcome data were collected from each identified case. Results Twenty-two cases of CSBO were identified within the study period; the median age was 73 years with a male predominance (73%). High rates of comorbid disease were detected, with a median Charlson Comorbidity Index score of 5. Diabetes mellitus was the most frequently observed condition. Six cases had bone sampling for microbiological diagnosis while the remainder had superficial sampling of contiguous structures. The most common pathogen isolated was Pseudomonas aeruginosa followed by Staphylococcus aureus, with only 1 case of fungal infection. This series demonstrated a mortality rate of 31.8%, with 45.5% of cases left with long-term sequelae including persistent pain and cranial nerve deficits. Conclusions Four key observations emerged in this series: (1) advanced age and diabetes mellitus are common risk factors for CSBO, (2) limited surgical intervention occurred, (3) microbiological diagnoses relied primarily on superficial sampling, and (4) significant mortality and morbidity was observed. Prospective studies are needed to better understand the optimal approach to the diagnosis and management of CSBO and to improve clinical outcomes.

A frailty census of older adults in the emergency department and acute inpatient settings of a model 4 hospital in the Mid-West of Ireland

Abstract Background Frailty is a risk factor for presentation to the ED, in-hospital mortality, prolonged hospital stays and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty. The aim of this cross-sectional study was to establish the prevalence of frailty and co-morbidities among older adults in an acute hospital setting. Methods Data collection was undertaken by clinical research nurses and advanced nurse practitioners experienced in assessing older adults. All patients aged ≥ 65 years and admitted to a medical or surgical inpatient setting between 08:00 and 20:00 and who attended the ED over a 24-h period were screened using validated frailty and co-morbidity scales. Age and gender demographics, Clinical Frailty Scale (CFS), Charlson Co-morbidity Index (CCI) and admitting specialty (medical/surgical) were collected. Descriptive statistics were used to profile the cohort, and p values were calculated to ascertain the significance of results. Results Within a sample of 413 inpatients, 291 (70%) were ≥ 65 years and therefore were included in the study. 202 of these 291 older adults (70%) were ≥ 75 years. Frailty was investigated using validated clinical cut-offs on the CFS (not frail < 5; frail ≥ 5). Comorbidities were investigated using the Charlson Comorbidity Index (mild 1–2; moderate 3–4; severe ≥ 5). The median CFS was 6 indicating moderate frailty levels, and the median CCI score was 3 denoting moderate co-morbidity. In the inpatient cohort, 245 (84%) screened positive for frailty, while 223 (75%) had moderate-severe co-morbidity (CCI Mod 3–4, severe ≥ 5). No significant differences were observed across genders for CFS and CCI. In the ED, 81 patients who attended the ED were ≥ 65 years. The median CFS was 6 (moderate frailty), and the median CCI was 5 (severe co-morbidity level). Seventy-four percent (60) of participants screened positively for frailty (CFS ≥ 5), and 31% (25) had a CFS of 7 or greater (severely frail). Ninety-six percent (78) of patients had a moderate-severe level of comorbidity. No significant associations were found between the CFS and CCI and ED participants age, gender, and medical/surgical speciality usage. Conclusion There is a high prevalence of frailty and co-morbidity among older adults who present to the ED and require inpatient care. This may contribute to increased waiting times, lengths of stay, and the need for specialist intervention. With an increased focus on the integration of care for older adults across care transitions, there is a clear need for expansion of frailty-based services, staff training in frailty care and multidisciplinary team resources across the hospital and community setting.

Characteristics, Outcome and Prognostic Factors of Patients with Emergency Department Cardiac Arrest: A 14-Year Retrospective Study.

Introduction: Cardiac arrests are traditionally classified according to the setting in which they occur, including out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). However, cardiac arrests that occur in the emergency department (EDCA) could constitute a third category, due to the peculiar characteristics of the emergency department (ED). In recent years, the need to study EDCAs separately from other intra-hospital events has emerged. The aim of this study was to describe the characteristics and outcomes of a cohort of patients experiencing EDCA in an Italian hospital over a 14-year period. Methods: This was a single-centre retrospective observational study conducted in the ED of the Santa Croce e Carle Hospital in Cuneo, Italy. All adult patients who experienced EDCA between 1 January 2010 and 30 June 2023 were included. OHCA patients, those arriving in the ED with on-going resuscitation measures, patients with EDCA not undergoing resuscitation, and patients with post-traumatic cardiac arrest were excluded from the study. The main outcome of the study was survival at hospital discharge with a favourable neurological outcome. Results: 350 cases of EDCA were included. The median age was 78 (63-85) years, and the median Charlson Comorbidity Index score was 5 (3-6). A total of 35 patients (10%) survived to hospital discharge with a cerebral performance category (CPC) Score of 1-2; survival in the ED was 28.3%. The causes of cardiac arrests were identified in 212 cases (60.6%) and included coronary thrombosis (35%), hypoxia (22%), hypovolemia (17%), pulmonary embolism (11%), metabolic (8%), cardiac tamponade (4%), toxins (2%) and hypothermia (1%). Variables associated with survival with a favourable neurological outcome were young age, a lower Charlson Comorbidity Index, coronary thrombosis as the primary EDCA cause, and shockable presenting rhythm; however, only the latter was associated with the outcome in a multivariate age-weighted model. Conclusions: In a cohort of patients with EDCA over a period of more than a decade, the most frequent cause identified was coronary thrombosis; 10% of patients survived with a good neurological status, and the only factor associated with the best prognosis was presenting a shockable rhythm. EDCA should be considered an independent category in order to fully understand its characteristics and outcomes.

Immune-related adverse events in patients treated with immunotherapy according to corticosteroid exposure.

e14709 Background: Patients with cancer require treatment with corticosteroids for multiple reasons, including prevention of chemotherapy-related side effects. Although corticosteroid use has been associated with lower efficacy of immune checkpoint inhibitors (ICI) in some studies, whether corticosteroid exposure affects the presence and severity of immune-related adverse events (irAEs) remains unclear. Methods: Retrospective single-center study of patients diagnosed with solid tumors treated with ICI. Eligible patients were those who received at least one cycle of ICI and had at least 1 month of follow-up post-ICI initiation. Patient data were extracted from electronic medical records. Comparisons between groups were made based on steroid exposure (defined as the administration of >10 mg of prednisone or its equivalent for >10 days within a 30-day period or at any point during ICI treatment, excluding steroid treatment for irAEs). Associations between variables were assessed using independent samples T-test, Chi-square, and Fisher’s exact tests. Results: We included 135 patients (mean age 61 years, SD 13); 72 (54%) were male. Forty-two (31%) had been exposed to steroids (mean prednisone equivalent of 427 mg, SD 298). Most patients received ICI as palliative treatment for advanced disease (105/135; 78%), primarily as first-line therapy (79/105; 75%). Patients exposed to corticosteroids were more likely to have received ICI with chemotherapy (76% vs 1%, p<0.001), were younger (56 vs. 63 years, p=0.009), more likely to be female (62% vs. 39, p=0.014), and had lower median Charlson Comorbidity Index scores (2 vs. 3, p=0.026). Steroid-exposed patients were more likely to have employed ICI in the neoadjuvant or adjuvant settings (36 vs. 16%, p=0.024) or as third or subsequent line therapy (26 vs. 8%, p=0.044). There were no statistically significant differences in the frequency of irAEs of any grade based on steroid exposure (31% vs 41%, p=0.252). However, patients who were exposed to steroids were significantly less likely to delay or suspend ICI (10% vs. 32%, p=0.005). No other parameters were associated with the rate or severity of irAEs. Conclusions: Our findings suggest that corticosteroid exposure does not increase the frequency of irAEs in patients treated with ICI, but it is associated with a reduced likelihood of discontinuing ICI due to irAEs. These observations suggest that corticosteroids may play a beneficial role in managing patients undergoing immunotherapy, particularly in sustaining treatment continuity despite irAEs. This study underscores the need for further investigation into optimal steroid use strategies to enhance patient outcomes with immunotherapy, especially in situations when they are commonly prescribed, such as premedication for chemotherapy.

Extracorporeal Membrane Oxygenation for Acute Lung Injury in Idiopathic Inflammatory Myopathies-A Potential Lifesaving Intervention.

Idiopathic inflammatory myopathies (IIM) can present with acute IIM-related lung injury and respiratory failure, leading to a high mortality risk in intensive care units (ICU). Extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome can be lifesaving. We aimed to report a case series of IIM patients that received ECMO. Patients with IIM from tertiary care centers in Belgium, Canada, Denmark, United States, and Sweden who underwent ECMO were reviewed to describe clinical characteristics, disease outcomes and hospitalization course. Clinical characteristics at admission and during ICU stay including ECMO complications and mortality causes were summarized. The study included 22 patients (50% female, mean±SD age at admission 47 ± 12 years) with anti-MDA5 positive dermatomyositis (68%), anti-synthetase syndrome (14%), polymyositis (9%), overlap myositis (5%) and non-MDA5 dermatomyositis (5%). Patients had low comorbidity scores and 46% had received immunosuppression before their ICU admission. Eight (36%) patients died in the ICU, six (27%) were bridged to recovery and eight (36%) were bridged to transplant. When comparing patients bridged to recovery and those who died in the ICU, those who died were older (p= 0.03) and had higher median Charlson comorbidity index scores (p= 0.05). Both groups had similar frequencies of ECMO-related complications (33% vs 50%, p= 0.94). In the patients exposed to ECMO in this case series, 14 were successfully bridged to recovery or transplant, while 8 died in the ICU. Large studies are needed to collect data on clinical outcomes in patients with IIM-ILD exposed to ECMO to identify the best candidates for the intervention.

Effectiveness and Safety of the Coadministration of Rifampin and Warfarin versus Direct Oral Anticoagulants: A Cohort Study.

Pharmacokinetic studies have shown that rifampin reduces the levels of oral anticoagulants during the initiation of coadministration, raising concerns about an increased thrombotic risk, but there are limited comparative clinical outcomes between rifampin and warfarin compared with direct oral anticoagulants (DOACs). This study aimed to evaluate the effectiveness and safety of concurrent use of rifampin and warfarin versus DOACs, with assessments of outcome-associated factors and oral anticoagulant (OAC) management quality. A total of 142 patients given rifampin plus warfarin (n = 56) or DOACs (n = 86) for over 7 days were included, and their clinical data and outcomes were compared. The median Charlson Comorbidity Index and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs/alcohol concomitantly) score of the two groups were 2 and 3, respectively. The incidence rate of composite ischemic or thromboembolic events was 2.16 and 1.44 per 10,000 patient-days in the warfarin and DOAC groups, respectively, with an adjusted hazard ratio (HR) of 0.41 (95% confidence interval [CI] 0.02-7.34). The incidence rate of composite major bleeding or clinically relevant nonmajor bleeding events was 1.58 and 1.52 per 10,000 patient-days in the warfarin and DOAC groups, respectively, with an adjusted HR of 1.12 (95% CI 0.32-4.45). The risk of composite bleeding events increased with a higher HAS-BLED score (HR: 1.62, 95% CI: 1.02-2.63). Moreover, 34.3% of warfarin users maintained a percent time in therapeutic range of above 50%. Furthermore, 77.9% of DOAC users received appropriate dosing. No significant differences were observed in terms of the incidence of thrombotic or bleeding events between the two groups during coadministration. In addition, a higher HAS-BLED score was associated with a greater risk of bleeding events regardless of the class of OACs used. Finally, close monitoring of bleeding events should be considered.

Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis.

Central Illustration : Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis. SHARPEN was the first dedicated score for in-hospital mortality prediction in infective endocarditis (IE) regardless of cardiac surgery. To analyze the ability of the SHARPEN score to predict in-hospital and post-discharge mortality and compare it with that of the Charlson comorbidity index (CCI). Retrospective cohort study including definite IE (Duke modified criteria) admissions from 2000 to 2016. The area under the ROC curve (AUC-ROC) was calculated to assess predictive ability. Kaplan-Meier curves and Cox regression was performed. P-value < 0.05 was considered statistically significant. We studied 179 hospital admissions. In-hospital mortality was 22.3%; 68 (38.0%) had cardiac surgery. Median (interquartile range, IQR) SHARPEN and CCI scores were 9(7-11) and 3(2-6), respectively. SHARPEN had better in-hospital mortality prediction than CCI in non-operated patients (AUC-ROC 0.77 vs. 0.62, p = 0.003); there was no difference in overall (p = 0.26) and in operated patients (p = 0.41). SHARPEN > 10 at admission was associated with decreased in-hospital survival in the overall (HR 3.87; p < 0.001), in non-operated (HR 3.46; p = 0.006) and operated (HR 6.86; p < 0.001) patients. CCI > 3 at admission was associated with worse in-hospital survival in the overall (HR 3.0; p = 0.002), and in operated patients (HR 5.57; p = 0.005), but not in non-operated patients (HR 2.13; p = 0.119). Post-discharge survival was worse in patients with SHARPEN > 10 (HR 3.11; p < 0.001) and CCI > 3 (HR 2.63; p < 0.001) at admission; however, there was no difference in predictive ability between these groups. SHARPEN was superior to CCI in predicting in-hospital mortality in non-operated patients. There was no difference between the scores regarding post-discharge mortality.

Recent Advancements in Acute Myeloid Leukemia Have Led to Incremental Improvement in Overall Survival

Background: Treatment approaches in acute myeloid leukemia are rapidly evolving due to a dynamic treatment landscape, routine molecular profiling, and the detection of measurable residual disease. Recently, there has been a surge in FDA approvals for novel therapies (e.g., midostaurin, gilteritinib, CPX-351, enasidenib, ivosidenib, and venetoclax), as well as a departure from a “one-size-fits-all” treatment approach. It is unclear, however, what effect these changes have had on overall survival over time. Since 2017, we have witnessed a significant introduction of novel therapeutics. We hypothesized that patients diagnosed after 2017 may have improved survival due to recent therapeutic advances. Methods: We retrospectively analyzed 627 consecutive patients in the Project ERIS database aged &amp;gt; 18 years with AML treated at VCU Massey Comprehensive Cancer Center from 2015 to 2022. We limited the analysis to January 1, 2015 to December 31, 2019 to avoid confounding from the COVID-19 pandemic. We obtained cytogenetic and molecular characteristics, induction regimens, allogeneic stem cell transplant status, and survival data. The median overall survival (mOS) was compared across calendar years using the Kaplan-Meier method. Categorical variables were analyzed using Fisher's exact test. Results: The median age at AML diagnosis was 62.9 years (range, 19.6-93.0), and the median ECOG performance status was 1 (range, 0-4). The median Charlson Comorbidity Index score was 5 (range, 0-14). There were 139 (22.2%) patients with ELN 2022 favorable-risk disease, 199 (31.7%) with intermediate risk, and 260 (41.5%) with adverse risk. The median OS of all patients diagnosed with AML in 2015 was 8.8 months. In 2016, the mOS was 14.5 months. There was a statistically significant improvement in mOS in 2016 compared to 2015 (HR 0.62 [95% CI 0.40-0.95], p = 0.027). The mOS in 2017, 2018, and 2019 was 12.9 months, 11.1 months, and 19.7 months, respectively. A significant improvement in OS was noted between 2015 and 2019 (HR 0.55 [95% CI 0.36-0.85], p = 0.003) in the entire cohort (Figure 1). When stratified by ELN 2022 genetic risk, clinically relevant improvement in OS was noted across all risk categories from 2015 to 2019, which reached statistical significance in the adverse risk group - favorable risk mOS: 16.4 months vs not reached (p = 0.141); intermediate risk: 13 months vs 18.7 months (p = 0.064); adverse risk: 7.2 months vs 13 months (p = 0.02). We observed expected changes in front-line treatment in this timeframe with decreased single-agent hypomethylating agent (HMA) usage in favor of HMA + venetoclax and increased intensive induction therapies outside of 7+3 (Figure 2). Strikingly, increased procession to allogeneic stem cell transplantation (HCT) was noted in the same timeframe (18.9% in 2015 vs 35.1% in 2019, p = 0.049). Conclusions : Our data demonstrate an emerging trend of clinically significant improvement in overall survival in patients with AML. The introduction of a multitude of therapeutic options may be associated with significantly improved survival over time. In addition to the advent of novel therapeutics leading to improved outcomes, the refinement of SCT conditioning regimens has likely led to the improved accessibility of HCT. In summary, we present an encouraging and significant trend of improved survival and access to HCT, particularly for patients with adverse-risk disease.

Polypharmacy Independently Predicts Overall Survival in Patients with Lymphoid Cancer

Introduction Comorbidity is common among patients with lymphoid cancer (LC) and may limit treatment options. Often, comorbidity is accompanied by medication leading to polypharmacy in multimorbid patients. Whereas comorbidity is difficult to eliminate, discontinuing inappropriate medication may offer an attractive modifiable risk. Aim To investigate the effect of polypharmacy and comorbidity on overall survival (OS) in patients with LC. Methods We retrieved data on all Danish patients registered with chronic lymphocytic leukemia (CLL) from the Danish CLL Register since 2008 and with mantle cell lymphoma (MCL), diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma (FL) from the Danish Lymphoma Register since 2005. All patients were diagnosed before June 2019; those with more than one LC diagnosis were excluded. Baseline data were used to calculate international prognostic indices (IPI). International Classification of Diseases (ICD10) diagnosis codes were retrieved from the Danish Patient Register, and Charlson comorbidity index (CCI) scores were calculated (Quan et al., Am J Epidemiol, 2011) at time of LC diagnosis. All patients were given a hematological CCI score of 2. Information on medication prescribed within the year up until LC diagnosis was retrieved from the Danish Prescription Register, and the number of drug classes (using the third ATC level, e.g. C03) was used to define polypharmacy as at least 5 drug classes. OS was calculated from time of diagnosis until death or end of follow-up. Multivariable analyses were equally adjusted for CCI, polypharmacy, and appropriate IPI. Results We identified 15,314 patients with LC including 5155 with CLL, 953 with MCL, 6182 with DLBCL, and 3024 with FL. The median age was 69 years (IQR 60;76). CLL-IPI and R-IPI are provided in the Figure. MIPI was low, intermediate, and high in 137 (15%), 297 (32%), and 493 (53%) patients, respectively, and FLIPI2 was low, intermediate, and high in 391 (16%), 1469 (62%), and 518 (22%), respectively. The median CCI score was 2 (including the hematological CCI score of 2, IQR 2;2). Most common comorbidities included chronic pulmonary disease (5%), congestive heart failure (CHF; 3%), rheumatic disease (RD; 3%), and metastatic cancer (MC; 2%). MC (3% vs 1-2%), RD (4% vs 2%), and AIDS (0.3% vs 0.0%) were significantly more prevalent in DLBCL as compared with other LCs ( P≤0.00054). Patients had most frequently been prescribed antibacterial (J01; 50%), analgesic (N02; 40%), renin-angiotensin system (C09; 33%), antithrombotic (B01; 32%), lipid modifying (C10; 30%), anti-inflammatory/rheumatic (M01; 29%), dyspepsia related (A02; 27%), and diuretic (C03; 27%) drugs. Antibacterials (54% vs 46-51%), analgesics (46% vs 33-36%), dyspepsia related (32% vs 22-28%), anti-inflammatory/antirheumatic (33% vs 24-28%), and systemic corticosteroid (H02; 13% vs 6-8%) drugs were being prescribed significantly more often in patients with DLBCL as compared with those with other LCs ( P&amp;lt;0.0001). In multivariable analyses adjusted for disease specific IPIs and CCI (2 vs &amp;gt;2), polypharmacy (&amp;lt;5 vs ≥5) was an independent prognostic marker of OS in CLL (hazard ratio [HR] 1.7, 95% confidence interval [CI]; 1.5;2.0), MCL (HR 1.4, 95% CI 1.2;1.7), DLBCL (HR 1.6, 95% CI 1.5;1.8), and FL (HR 1.8, 95% CI 1.6;2.1; P&amp;lt;0.0001). Using polypharmacy as a continuous variable (0-2 vs 3-4 vs 5-6 vs 7-8 vs 9-10 vs &amp;gt;10), we further demonstrated a dose-response effect on OS in CLL, DLBCL (Figure), MCL, and FL (data not shown). Similar to CLL and DLBCL, FL with &amp;gt;2 drug classes were significantly associated with shorter OS, whereas in MCL, polypharmacy groups were small ( n≤262) and only significantly associated with shorter OS for groups with ≥5 drug classes. Conclusion Polypharmacy is an important prognostic marker of OS independent of the CCI and IPIs in CLL, MCL, DLBCL, and FL. Polypharmacy is most likely a result of an underlying comorbidity, still informing the prognosis further than register based CCI scores. Further studies will seek to clarify the extent of medication that may be considered for discontinuation in newly diagnosed patients. Moreover, these results indicate that consistent collection of data on both comorbidity and polypharmacy at baseline in clinical trials may improve subgroup analyses and clinical translation of results. This is particularly important when extrapolating clinical trial results to ineligible populations.

Impact of COVID-19 Pandemic on Overall Survival in Acute Myeloid Leukemia: A Comprehensive Cancer Center Experience of 627 Patients

Background: The COVID-19 pandemic impacted cancer care nationwide. Challenges with frequent clinic visits for lab draws, administration of multi-agent chemotherapy regimens, and scarcity of supportive blood products disrupted effective health care delivery. The magnitude of these factors on the survival of patients diagnosed with acute myeloid leukemia (AML) during the pandemic is incompletely described. Methods: We included 627 patients aged ≥18 years with AML treated at VCU Massey Comprehensive Cancer Center from January 1, 2013 to December 31, 2022; we recorded baseline demographics, molecular profiles, induction regimens, and survival data. We defined the pandemic era as March 7, 2020 (coinciding with the first confirmed case in our region) to July 1, 2021 (routine and widespread vaccination available). Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. ECOG and Charlson comorbidity index (CCI) scores were compared using the Mann-Whitney test; we used the D'Agostino &amp; Pearson method for normality testing. Results: The median age of patients who received intensive chemotherapy (7+3, CPX-351, FLAG-IDA, MEC, or HAM) in the COVID-19 pandemic cohort was 60 years (range, 28.5-69.6) vs 58 years (range, 19.6-81.4) for the non-COVID-19 cohort (p = 0.932). The median ECOG performance status in both cohorts was 1 (range, 0-4, p = 0.658). The median Charlson comorbidity index (CCI) score for patients for both groups was 4 (range, 0-9 vs 2-9, p = 0.909). Patients who were initiated on lower-intensity therapies (e.g., a hypomethylating agent with or without venetoclax) during the COVID-19 pandemic had a median age of 75 (range, 61.9-85.1) years vs 73 (range, 26.1-92.0) years in the non-COVID-19 cohort (p=0.438). The median ECOG performance status for the COVID-19 cohort was 2 (range, 0-3) vs 1 (range, 0-4) for the non-COVID-19 cohort (p=0.005). CCI score for both groups was 6 (range, 4-12 vs 2-14, p=0.789). We then compared the mOS between the COVID-19 and non-COVID-19 eras for both intensive and non-intensive treatment cohorts. For patients treated with intensive chemotherapy during the pandemic, the mOS was 25.1 months in the COVID-19 cohort vs 18.0 months (p = 0.173) in the non-COVID-19 cohort. For patients treated with non-intensive regimens, mOS was 6.6 months in the COVID-19 cohort vs 6.0 months in the non-COVID-19 cohort (p = 0.963). Patients with relapsed disease who were retreated with intensive chemotherapy during the COVID-19 pandemic had a mOS of 6.5 months compared to 8.2 months (p = 0.094) in the non-COVID-19 cohort. Relapsed patients in the lower-intensity COVID-19 cohort had a significantly shorter mOS of 1.8 months compared to 5.2 months in the non-COVID-19 cohort (p = 0.005). Regardless of therapy, the mOS was shorter in the COVID-19 cohort at 11.0 months compared to 13.4 months in the non-COVID-19 cohort (p = 0.191). Relapsed or refractory patients in the COVID-19 cohort had significantly shorter mOS at 5.8 months compared to 8.0 months in the non-COVID-19 cohort (p = 0.019). Discussion: The median overall survival appears shorter for patients diagnosed with AML during the COVID-19 pandemic. Patients with relapsed or refractory AML appeared to have significantly worse overall survival during the COVID-19 pandemic, particularly with lower-intensity therapies. Patients treated with less-intensive regimens are generally older with increased frailty, raising concern for lack of physiologic reserve. These results convey a lesson in preparation for future healthcare crises.

144. Impact of Rapid Identification and Resistance Gene Detection using an Algorithm-Based Approach in Gram-Negative Bacteremia

Abstract Background Time to appropriate antimicrobial therapy is the most important predictor of survival among patients with sepsis due to Gram-negative bacteria (GNB). Infections due to multidrug-resistant (MDR) pathogens often result in inappropriate empiric treatment (tx). The GenMark ePlex identifies organisms and resistance markers within 1.5 hours from blood culture positivity compared to 48-72 hours by conventional methods. Methods We are conducting a single-center study to assess outcomes before and after ePlex implementation. The pre-intervention period included patients with GN bacteremia from January to June 2021. Patients were excluded if they received comfort-only care within 48 hours, had polymicrobial GN bacteremia, or were infected by an organism not on the ePlex panel. Primary outcome is time to in-vitro active therapy from blood culture collection. Results 208 patients were identified during the pre-intervention period; 154 met inclusion criteria. Median age was 64 years, 49% were male, and 28% were immunocompromised. Median (IQR) Charlson Comorbidity index and Pitt Bacteremia scores were 6 (4-8) and 2 (1-8), respectively (Table 1). 16% of patients were infected by MDR GNB and 21% received inactive empiric tx. Overall median (IQR) time to in-vitro active tx was 3.9 (1–19) hours, but was 39.5 (13.6-71.9) hours among those who received inactive empiric tx. Median (IQR) time to first antibiotic modification was 2.7 (1.0-3.4) days. 38% of patients were transitioned to oral antibiotics at a median (IQR) of 4.2 (3.1-6.1) days. The median (IQR) duration of tx was 15 (10-17) days; 4.5% of patients were treated with ≤ 7 days. Median (IQR) length of hospitalization was 15.5 (7-36) days. 7.8% were re-admitted within 30 days (Table 2). In-hospital and 30-day mortality rates were numerically higher among patients who received inactive empiric therapy (27% and 21%, respectively) when compared to patients who received active empiric therapy (16.5% and 12%, respectively) (Figure 1). Results Table 1: Patient demographics, underlying conditions and infection and treatment characteristics in the pre-intervention group Results Table 2 Results Figure 1 Conclusion Our pre-intervention data highlight opportunities to improve the management of GN bacteremia. Implementation of ePlex is likely to decrease the proportion of patients treated with inactive therapy, shorten time to optimal tx and reduce lengths of stay. Disclosures Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support

Health Care Resource Utilization and Total Costs of Care for Adult Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia in the United States: A Retrospective Claims Analysis

PurposeAlthough immunotherapies such as blinatumomab and inotuzumab have led to improved outcomes, financial burden and health resource utilization (HRU) have increased for adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia (R/R B-ALL). This study assessed real-world HRU and costs of care among adult patients with R/R B-ALL by line of therapy (LoT) in the United States. MethodsWe selected patients from the MarketScanⓇ Database (January 1, 2016 through December 31, 2020) as follows: ≥1 claims of ALL-indicated first-line (1L) therapies, ≥1 diagnosis of ALL before the index date (1L initiation date), 6-month continuous enrollment before the index date, second-line (2L) therapy initiation, ≥18 years old at 2L, no clinical trial enrollment, no diagnosis of other forms of non-Hodgkin's lymphoma, and no claim for daratumumab or nelarabine during the study period. Outcome measures included claim-based time to next treatment (TTNT), all-cause and adverse event (AE)–related HRU, and all-cause and AE-related costs. FindingsThe R/R B-ALL cohort (N = 203) was 60% male, median age of 41 years, and median Charlson Comorbidity Index score of 3.0. Mean (SD) follow-up was 17.8 (11.8) months. Of those who received 2L, 55.7% (113/203) required 3L, and 15% (30/203) initiated 4L+. Patients relapsed quickly, with a median TTNT of 170 days, 169 days, and 205 days for 2L, 3L, and 4L+, respectively. Hospitalization rates were high across each LoT (2L, 88%; 3L, 73%; 4L+, 73%), and the mean (SD) inpatient length of stay increased by LoT as follows: 8.6 (6.8) days for 2L, 10.6 (13.3) for 3L, and 11.6 (13.6) for 4L+. Mean (SD) overall costs were substantial within each LoT at $513,279 ($599,209), $340,419 ($333,555), and $390,327 ($332,068) for 2L, 3L, and 4L+, respectively. The mean (SD) overall/per-patient-per-month AE-related costs were $358,676 ($497,998) for 2L, $202,621 ($272,788) for 3L, and $210,539 ($267,814) for 4L+. Among those receiving blinatumomab or inotuzumab within each LoT, the mean (SD) total costs were $566,373 ($621,179), $498,070 ($376,260), and $512,908 ($159,525) for 2L, 3L, and 4L+, respectively. ImplicationsThese findings suggest that adult patients with R/R B-ALL relapse frequently with standard of care and incur a substantial HRU and cost burden with each LoT. Those treated with blinatumomab or inotuzumab incurred higher total costs within each LoT compared with the overall R/R B-ALL cohort. Alternative therapies with longer duration of remission are urgently needed, and HRU should be considered for future studies examining the optimal sequencing of therapy.

Abstract 12875: Echocardiographic Findings Associated With Subsequent Risk of Native Valve Endocarditis

Introduction: The association of echocardiographic measurements and subsequent risk of left-sided native valve endocarditis (LS-NVE) is undefined. Aim: To determine if transthoracic echocardiographic (TTE) measurements are associated with the subsequent development of LS-NVE in patients without recognized cardiac predisposing conditions. Methods: Institutional databases were evaluated for adults diagnosed with LS-NVE from 2008 to 2020. Patients with prosthetic valves, cardiovascular implantable electronic devices, intracardiac devices, injection drug use, and recognized predisposing cardiac conditions were excluded. Patients with a TTE performed 6 months to 3 years before developing LS-NVE were included as cases. Controls were patients within the same Mayo Clinic location with a TTE report and were matched in a 1:3 ratio according to age, gender, Charlson Comorbidity Index (CCI), and echocardiography date. Multivariate logistic-regression analyses adjusting significant variables between cohort's were performed. A p-value &lt;0.05 was considered significant. Results: There were 148 cases and 431 matched controls. The median age was 63.8 (IQR: 53.6 - 74.6) years, and 329 (56.8%) patients were males. LS-NVE cases had a higher prevalence of diabetes mellitus (46.6% vs. 30.4%) and chronic kidney disease (46.6% vs. 28.1%) when compared with controls (p&lt;0.001 both). The median CCI score was 3 (IQR: 0-6) for cases and 2 (IQR: 0-6) for controls. After performing adjusted analyses, left ventricular outflow tract velocity (p=0.017), left ventricular ejection fraction (p=0.018), and E: e’ ratio (p=0.050) were associated with the development of LS-NVE ( Figure 1) . Conclusions: Echocardiographic measurements were associated with subsequent LS-NVE development in this preliminary investigation. A larger cohort of LS-NVE patients is needed to validate these findings.

Treatment Intensity and Outcomes in Elderly Patients with DLBCL Receiving First Line Therapy

Background: One-third of patients (pts) with newly diagnosed DLBCL are 70 and older. Although a standard of care for first-line (1L) DLBCL is anthracycline-based chemoimmunotherapy with R-CHOP, in elderly DLBCL pts treatment approaches vary and outcomes of these are poorly understood. In this study, we aimed to evaluate long-term outcomes among elderly pts with DLBCL across 1L regimens with a focus on those who received reduced dose (RD) R-CHOP, standard dose (SD) R-CHOP, and non-anthracycline alternative regimens (AR). Methods: We evaluated a cohort of pts from the Flatiron Health electronic health record (EHR)-derived, de-identified database with DLBCL diagnosis (dx) after 1/1/2011, age 70 or greater at dx, and with no evidence of prior indolent lymphoma or other malignancy within 2 years of 1L therapy. RD R-CHOP was defined as &amp;lt;80% SD doxorubicin or cyclophosphamide. Time-to-event analysis was performed with the Kaplan-Meier method and differences were evaluated using the log rank test. Real world overall survival (rwOS) was defined as the interval, in months (mos), from DLBCL dx to death or last follow-up. Real world progression free survival (rwPFS) was defined as the interval, in mos, from initiation of 1L therapy to progression, death, or last follow-up. Multiple imputation was performed (m = 50). Multivariate Cox regression analysis (MVA) was conducted within each imputed dataset and pooled. MVA was additionally performed across age strata. Results: There were 434 pts included in the complete cohort. Eighty-six percent (N=372) received 1L therapy and 62 pts (14%) had no therapy documented. Among treated pts, 47% were female, median age was 79 (IQR 75-82), and median CCI score 7 (IQR 6-9). Twenty-six percent and 47% had limited and advanced stage at dx, respectively; stage was unknown in 27%. Cell of origin was germinal center (GCB), non-GCB, and unknown in 34%, 24%, and 43%, respectively. Forty-eight percent of pts (N=212) received R-CHOP as 1L. Best real world response (rwR), defined as either complete response (CR) or partial response (PR) to 1L, was 89.0%, 89.5%, and 81.6% (p = 0.20) in pts who received SD R-CHOP, RD R-CHOP, and AR, respectively. CR rates were 78.0%, 58.1%, and 60.2% (p = 0.008) among these cohorts, respectively. Median rwOS and rwPFS among all treated pts was 39.0 mos (32.4-47.3) and 15.2 mos (12.3-23.4), respectively. Among patients who received SD R-CHOP, RD R-CHOP, and AR, median age (IQR) was 72 (71-77), 81 (79-83), and 80 (77-81), respectively (p&amp;lt;0.001). Median Charlson comorbidity index (CCI) score (IQR) was 6 (5-8), 8 (6-9), and 7 (6-9) across these groups, respectively (p&amp;lt;0.001). SD R-CHOP was associated with better rwPFS and rwOS in the entire treated cohort. Real world OS and rwPFS were 95.6 mos (67.0-NE) and 77.3 mos (40.3-NE) for SD R-CHOP, 37.6 mos (27.9-NE) and 15.8 mos (11.9-35.8) RD R-CHOP, and 25.7 mos (16.0-32.6) and 9.6 mos (8.1-12.0) for AR, respectively. When stratifying by age, pts 70-79 years had PFS of 77.3 mos (41.2-NE), 22.4 mos (9.86-NE), and 11.0 mos (8.6-23.4) with SD R-CHOP, RD R-CHOP, and AR, respectively (p &amp;lt;0.0001), whereas pts &amp;gt;=80 had PFS 6.14 mos (4.21-NE), 14.7 mos (8.87-NE), and 7.3 mos (4.47-12.0) with these regimens (p=0.03). In Cox regression MVA, CCI was associated with rwPFS in pts &amp;gt;=80 (HR 1.18, p=0.004). High-risk IPI score was associated with rwPFS (HR 2.13, p=0.05) and rwOS (HR 2.51, p=0.033), but only in pts age 70-79. When stratifying by age and adjusting for comorbidities, IPI, and MYC alteration, treatment with RD R-CHOP and AR were associated with inferior rwPFS and rwOS compared to SD R-CHOP among pts age 70-79, however, there was no association between treatment intensity and outcome among pts &amp;gt;=80 (Table). Conclusions: This study represents one of the largest real-world studies evaluating contemporary outcomes among elderly pts with DLBCL receiving 1L therapy. In MVA, SD R-CHOP is significantly associated with improved rwPFS and rwOS compared to RD-RCHOP and AR, but only among pts aged 70-79. There was no effect of treatment intensity or regimen on either rwPFS or rwOS among pts aged &amp;gt;=80. Other covariates significantly associated with outcome included CCI among pts &amp;gt;=80 and high-risk IPI in pts 70-79. These results suggest that pts aged 70-79 should receive SD R-CHOP whenever feasible, but that treatment intensity is not the primary determinant of outcomes among pts aged &amp;gt;=80. CCI should be part of routine evaluation in elderly DLBCL pts.

1448-P: Diabetes-Related Complications and Comorbid Conditions in Older Adults with Type 1 Diabetes (T1D) in a Large Geographically Diverse Health Care System

Older adults (age 65+) with T1D are an understudied population. Though many older adults may have long-standing diabetes and the prevalence of multimorbidity accumulates over the lifespan, the prevalence of diabetes-related complications and comorbid conditions in older adults with T1D have not been well-characterized, though these factors can affect quality of life. We analyzed electronic health record (EHR) data from older adults with T1D within a large public hospital system (n=560). We used ICD-10 diagnostic codes and calculated the proportion of the sample with different comorbidities and diabetes-related complications, as well as the average number of total complications and the Charlson Comorbidity Index Score (Table). The mean number of T1D-related complications was 3.93 with 29.6% (n=166) having 6+ concurrent T1D complications. The most common T1D complication was retinopathy or other ophthalmic complication with (72%; n=402). The median Charlson Comorbidity index score was 3. Nearly half of the sample (n=282; 50.4%) had cardiovascular disease and more than one third (n=197; 35%) had renal disease. These data underscore a high burden of diabetes complications and comorbidities among older adults with T1D. Understanding the medical complexity of this population can inform future research and intervention. Disclosure A.Kahkoska: None. J.M.Weinstein: Research Support; Dexcom, Inc. R.Muthukkumar: None. L.A.Young: Research Support; Novo Nordisk, Rhythm Pharmaceuticals, Inc., Eli Lilly and Company, Jaeb Center for Health Research, Sanofi, Boehringer-Ingelheim. Funding National Institutes of Health (KL2TR002490, UL1TR002489)

CEFTO-CURE study: CEFTObiprole Clinical Use in Real-lifE – a multi-centre experience in Italy

Ceftobiprole is approved in Europe for treatment of community-acquired pneumonia and non-ventilator-associated hospital-acquired pneumonia (HAP) in adults. Real-world data are limited. This multi-centre, observational, ambispective investigator-initiated study was undertaken in Italy from January 2018 to December 2019 in order to evaluate the use of ceftobiprole in a real-world setting. Overall, 195 patients from 10 centres were evaluated (68% retrospectively). Male sex was prevalent (n=121, 62%). Median age was 67 [interquartile range (IQR) 53-75] years. Median Charlson Comorbidity Index score was 5 (IQR 3-7). The most common indication was pneumonia (151/195, 77%), especially HAP. Other uses were skin and soft tissue infections (5%), endocarditis (4%) and bone infections (4%). Ceftobiprole was usually an empiric choice (65%), in combination with other drugs (66%) and as second-line therapy (58%). A causative agent was found in 39% of cases. A diagnosis of sepsis was made in 59 cases (30%). Success in the clinically evaluable population (excluding 12 cases due to isolation of pathogens outside ceftobiprole's spectrum of activity) was obtained in 79% of cases, with all-cause mortality of 20%. On multi-level analysis, three predictors were positively associated with clinical success: male gender, pneumonia and detection of causal agent. Sepsis was a negative predictor. Nine factors were independently associated, favourably or unfavourably, with fatal outcome. Ceftobiprole is a safe and effective therapeutic choice, even in a real-world setting. More data are needed to establish its efficacy in patients with sepsis.

Comparing Comorbidity Polypharmacy Score and Charlson Comorbidity Index in predicting outcomes in older trauma patients

BackgroundThe Charlson Comorbidity Index (CCI) and Comorbidity Polypharmacy Score (CPS) may potentially risk-stratify older trauma patients more accurately than traditional trauma severity scores. We aim to evaluate if CCI or CPS are better predictors of mortality and discharge venue in such patients. MethodsWe conducted a retrospective study using registry data from two tertiary trauma centres. Patients aged 65 years and above who presented to the emergency departments (EDs) between January 2011 and December 2015 with traumatic injuries were included. Charts were reviewed for demographics, injury mechanism and severity, discharge outcomes, and types of comorbidities and medications used. Primary outcome was overall mortality; secondary outcomes included ED disposition and hospital discharge venue. Discriminatory power of the score(s) were compared using area under the receiver operating characteristic (AUROC) curve. ResultsThere were 2,750 patients, with overall female predominance (56.7%, 1,560/2,750) and median age of 78 years (interquartile range [IQR] 72 to 84 years). Median CCI score was 1 (IQR 0 to 2) and median CPS was 8 (IQR 4 to 12). Overall mortality was 9.4% (259/2,750). Every 1-point increase in CCI score resulted in increased odds of death by 16% (adjusted odds ratio 1.16, 95% confidence interval 1.07 to 1.26, p<0.001). Addition of CCI to the Injury Severity Score (ISS) increased the discriminatory power for mortality (AUROC for ISS = 0.832; AUROC for ISS with CCI = 0.843). Every 1-point increase in CCI was significantly associated with decreased odds of admission to a rehab facility by 8%. CPS did not predict mortality and discharge venue. ConclusionCCI, but not CPS, was a predictor of mortality. A higher CCI was associated with decreased odds of discharge to a subacute facility, likely related to underlying rehabilitation potential. Further studies should be undertaken to explore an integrated scoring system that considers injury severity, comorbidities, and polypharmacy.

Association between Serum Biomarkers of Inflammation One Week after ICU Admission and Post-Discharge Mortality in Critically Ill Patients

Background: Delirium occurs among up to 80% of critically ill patients and is associated with poor patient outcomes. Levels of serum biomarkers of inflammation and astrocytic and glial activation measured at ICU admission are associated with increased delirium duration, delirium severity, and in-hospital mortality. The utility of measuring biomarkers at later points during ICU stay has not been elucidated.&#x0D; Objective: To determine how serum biomarker levels collected at one week of ICU stay are associated with mortality.&#x0D; Design: Observational study.&#x0D; Setting: Three Indianapolis hospitals.&#x0D; Patients: One hundred seventy-eight critically ill patients.&#x0D; Main Results: The median cohort age was 61 years (IQR 53.5-70.1), 56.2% were female, and 48.3% were African American. The median APACHE II score was 21.0 (IQR 16.0-27.0), and the median Charlson Comorbidity Index score was 3.0 (IQR 1.0-5.0). Approximately 76% were mechanically ventilated; 54% had acute respiratory failure and/or sepsis. Median ICU stay was 13 days (IQR 10.0-22.0).We analyzed the relationship between serum biomarkers of inflammation (interleukin-1, 6, 8, 10, and tumor necrosis factor α), neuroprotection (insulin-like growth factor 1), and astrocytic and glial activation (S-100β) and mortality 30 days post-discharge. Higher levels only of IL-6 and IL-10 at day 8 of ICU stay were associated with higher odds of death 30 days post-discharge (IL-6 OR: 2.45, 95% CI: 1.49, 4.03, p&lt;0.001; IL-10 OR: 2.07, 95% CI: 1.23, 3.49, p=0.006), while day 1 levels of the same biomarkers were not (IL-6 OR: 1.10, 95% CI: 0.72,1.70, p=0.662; IL-10 OR: 1.40, 95% CI: 0.88, 2.25, p=0.157).&#x0D; Conclusion: Measuring serum biomarkers of systemic inflammation one week after ICU admission may be more useful than measuring at ICU admission for predicting longer-term outcomes in critically ill patients.

978. Effectiveness of oral cephalexin as completing treatment for bacteremic vertebral osteomyelitis caused by Methicillin-susceptible Staphylococcus aureus

Abstract Background Methicillin-susceptible Staphylococcus aureus (MSSA) is the most common causative microorganism of pyogenic vertebral osteomyelitis (VO). Oral antimicrobial therapy with first-generation cephalosporins can treat MSSA infection, but data on pyogenic VO are scarce. Methods This retrospective study included adult patients treated with oral cephalexin as the completing treatment for pyogenic VO with bacteremia due to MSSA at the National Center for Global Health and Medicine Hospital, Japan from 2012 to 2020. Treatment effectiveness of cephalexin was evaluated by comparing the improvement in symptoms and laboratory and imaging results after intravenous (IV) administration of antimicrobial agents and after oral cephalexin treatment, using a 5-point scale (Table). A score of 4 or 5 indicated treatment success. Results This study included 15 patients (8 [53%] females), with median age 75 years (interquartile range [IQR], 67.5–80.5), median body weight 57.0 kg (IQR, 45.5–62.5), and median Charlson comorbidity index score 2 (IQR, 0–4). Ten patients (67%) had lesions in the lumbar spine. Six patients had lesions at multiple sites (cervical and thoracic, n=1; cervical and lumbar, n=2; thoracic and lumbar, n=1; and lumbar and sacral, n=2). Twelve patients (80%) had spinal abscesses and four (27%) had remote abscesses, but none had concomitant endocarditis. In 11 patients with normal renal function, 1,500–2,000 mg/day of cephalexin was administered. Surgical intervention was performed in five cases (33%). The median duration of IV antibiotics, cephalexin, and total treatment was 36 (IQR, 32–61; range, 21–86), 29 (IQR, 19–82; range, 8–251), and 86 (IQR, 59–125; range, 37–337) days, respectively. Majority patients (≥80%) received either cefazolin or ceftriaxone as IV therapy. Two patients used oral antimicrobials other than cephalexin outside of the cephalexin treatment period. Treatment success rate after cephalexin therapy was 87%. None of the patients had recurrence during a median follow-up of 119 days (IQR, 48.5-350). Conclusion In patients with bacteremic VO due to MSSA, completing treatment with cephalexin is a reasonable option, even in cases with spinal abscess, if at least 3 weeks of effective IV antimicrobial therapy is provided. Disclosures All Authors: No reported disclosures.